ABSTRACT
The contradiction that is India is well illustrated in this chapter. Ramanathan and Weerakon note that although India is in various ways a modern society, it is also a sexually conservative society which values sexual purity over the erotic. While the Internet makes sexual content easy to access for young Indian men and women, this content is often at odds with the values and practices espoused by religious leaders, parents, and the larger community.
The effect of these contradictory and competing messages about sexuality is often confusion and anxiety. Ramanathan and Weerakoon observe that Western style sex therapy has not worked well on the Indian subcontinent, as demonstrated by the high dropout rate from treatment and the lack of significant treatment success. They attribute this failure to the Western emphasis on sexual pleasure inherent in therapy rather than on procreation, which is the primary concern of Indian couples. They also note that Asians do not commonly seek help for sexual disorders because they attribute the cause to their own “bad” behavior (often masturbation). Finally, the authors observe that challenging “irrational” beliefs, a mainstay of many psychotherapeutic approaches, is ineffective when the beliefs being challenged are culturally entrenched and currently reinforced by religion, family, and peers. Ramanathan and Weerakoon instead suggest a culturally sensitive approach to the treatment of male sexual dysfunction, which involves a psychological and medical collaboration. This approach is well illustrated in the detailed case presentation of the treatment of a young man with masturbatory guilt and sexual anxiety.
Sadly, the wealth of information contained in this chapter will not be as helpful in addressing the sexual concerns of Indian women. This does not refl ect a bias on the authors’ part, but rather the traditional culture of India. The authors remark that women in India have little control over their sexuality and over life decisions that impact it; they note, for example, that many Indian women have little or no choice in whom they marry or when, nor do they have a say in the timing or number of their children. Sexual “purity” or virginity is of the utmost importance for women prior to marriage, while after marriage the ability to give birth to a male child is paramount. While some women in India have achieved professional status and perhaps even fi nancial independence, this autonomy often does not extend to sexuality. Indeed, as discussed in the chapter, sexual and domestic violence and sex traffi cking are real problems facing many Indian girls and women. It appears that sexual pleasure for women in India will not be a priority until women in India are accorded equal status with men and have control over their lives and their sexuality.
After reading this chapter, it is not hard to see that there is an important role for a culturally sensitive approach to sex therapy in India. The blending of medical and psychological treatment the authors illustrated in their case presentation provides a workable model for how to successfully engage Indian men and treat their sexual dysfunctions and anxieties.
